Provider Demographics
NPI:1831434331
Name:INLAND MEDICAL CONSULTANTS, LLC
Entity type:Organization
Organization Name:INLAND MEDICAL CONSULTANTS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/AO
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:951-858-5439
Mailing Address - Street 1:319 E PALM DR STE A
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-3238
Mailing Address - Country:US
Mailing Address - Phone:714-667-3832
Mailing Address - Fax:888-978-5154
Practice Address - Street 1:319 E PALM DR STE A
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-3238
Practice Address - Country:US
Practice Address - Phone:714-667-3832
Practice Address - Fax:888-978-5154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-10
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336S0011X, 3336C0004X
CA525433336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2138237OtherPK